经皮冠状动脉介入治疗后一年随访研究中的主要不良心血管事件（MACE）
Major adverse cardiovascular event (MACE) after percutaneous coronary intervention in one-year follow-up study.
作者信息
Farshidi Hossein, Abdi Ahmadnoor, Madani Abdulhussain, Moshiri Shahram, Ghasemi Abolfazl, Hakimian Ruhollah
机构信息
M.D., Interventional Cardiologist, Associate Professor of Cardiology, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
M.D. Interventional Cardiologist, Assistant Professor of Cardiology, Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
出版信息
Electron Physician. 2018 Feb 25;10(2):6383-6389. doi: 10.19082/6383. eCollection 2018 Feb.
BACKGROUND
Percutaneous coronary intervention (PCI) is the most common revascularization procedure, with over 1 million performed each year, worldwide. Over the past 20 years, the increasing experience of operators coupled with the advent of newer technologies, including coronary stents and a variety of adjuvant drug therapies, have permitted more successful procedures and decreased the morbidity associated with PCIs.
OBJECTIVE
To identify the incidence, predictors, and clinical implications of Major Adverse Cardiovascular Events (MACE) after PCIs.
METHODS
This descriptive cross-sectional study was done in Bandar Abbas in Iran in 2015. All patients which treated with PCI in Shahid Mohammadi Hospital during a one-year period were employed. A total of 192 patients were included. At one-year follow-up in this study, incidence and predictors of MACE were evaluated in a prospective study. The data were analyzed by SPSS 19.0 and descriptive tests included frequency and percentage and mean and standard deviation. Also, Chi-square test was used for data analysis. A p value <0.05 was determined as significant.
RESULT
Of the 192 patients, 126 (65.6%) were men and 66 patients were female. Stent had been implemented in 93.8% of patients. Sixty two percent of patients were treated with only one stent, two stents were deployed in 29.7% of patients and 3.6% of patients were treated with three or more stents. Of these patients, 46.9% were treated with Drug Eluted Stent (DES) and 40.1% were treated with Bare Metal Stent (BMS). Both types of stents were used in 8.3% of patients. Also, 4.7% of the patients were treated with balloon angioplasty (POBA). Angioplasty success rate was 95.3% and procedural success rate defined as achieving TIMI III flow with residual coronary stenosis under 30%. No in-hospital mortality or emergency CABG was reported. Re-admission in first year after PCI was required in 34 (17.7%) patients of which, 20 of them (10.4%) needed target vessel revascularization (TVR). Readmission was significantly higher (p=0.034) in the group with BMS compared to those who had DES. MI occurred in 8 patients.
CONCLUSION
Our study showed the superiority of DES in comparison with BMS in decreasing readmission and less TVR, but no effect on long term mortality. We recommend more studies in this setting because patients in special groups may benefit more from DES or BMS.
背景
经皮冠状动脉介入治疗（PCI）是最常见的血运重建手术，全球每年进行超过100万例。在过去20年中，术者经验的增加以及包括冠状动脉支架和各种辅助药物治疗在内的新技术的出现，使得手术更加成功，并降低了与PCI相关的发病率。
目的
确定PCI术后主要不良心血管事件（MACE）的发生率、预测因素及临床意义。
方法
这项描述性横断面研究于2015年在伊朗阿巴斯港进行。纳入了在沙希德·穆罕默迪医院接受为期一年PCI治疗的所有患者。共纳入192例患者。在本研究的一年随访中，通过前瞻性研究评估了MACE的发生率和预测因素。数据采用SPSS 19.0进行分析，描述性检验包括频率、百分比、均值和标准差。此外，采用卡方检验进行数据分析。p值<0.05被确定为具有统计学意义。
结果
192例患者中，126例（65.6%）为男性，66例为女性。93.8%的患者植入了支架。62%的患者仅植入一枚支架，29.7%的患者植入两枚支架，3.6%的患者植入三枚或更多支架。在这些患者中，46.9%接受了药物洗脱支架（DES）治疗，40.1%接受了裸金属支架（BMS）治疗。8.3%的患者同时使用了两种类型的支架。此外，4.7%的患者接受了球囊血管成形术（POBA）。血管成形术成功率为95.3%，手术成功率定义为达到TIMI III级血流且残余冠状动脉狭窄低于30%。未报告院内死亡或急诊冠状动脉旁路移植术（CABG）。PCI术后第一年，34例（17.7%）患者需要再次入院，其中20例（10.4%）需要靶血管血运重建（TVR）。与接受DES的患者相比，接受BMS的患者再次入院率显著更高（p = 0.034）。8例患者发生心肌梗死（MI）。
结论
我们的研究表明，与BMS相比，DES在降低再次入院率和减少TVR方面具有优势，但对长期死亡率无影响。我们建议在这种情况下进行更多研究，因为特殊群体的患者可能从DES或BMS中获益更多。
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